Provider Demographics
NPI:1316162290
Name:WETTER, AMY L
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:WETTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:FRERKING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:100 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1402
Mailing Address - Country:US
Mailing Address - Phone:660-259-4369
Mailing Address - Fax:660-259-4992
Practice Address - Street 1:LEXINGTON SCHOOL DIST R V
Practice Address - Street 2:100 S 13TH ST
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1402
Practice Address - Country:US
Practice Address - Phone:660-259-4369
Practice Address - Fax:660-259-4992
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005025497235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO467464301Medicaid